After more than a year of Ebola transmission in Guinea and more than 7 months of transmission in Liberia and Sierra Leone, there is still much to be done to stop the world’s first Ebola epidemic, CDC director Tom Frieden, M.D., M.P.H reported from his second visit to the three affected nations.
Dr. Frieden last week returned from West Africa, where he spoke with patients and staff; met with many of CDC’s 170 staff working in each of the countries; and met with the presidents, health ministers, and Ebola leadership of each country. He described the situation as both inspiring and sobering.

“It is inspiring to see how much better the response has become in the past two months, how much international commitment there is, and, most importantly, how hard people from each of the three countries are working to stop Ebola,” Dr. Frieden said. “But it is sobering that Ebola continues to spread rapidly in Sierra Leone and that in parts of Monrovia and Conakry Ebola is spreading unabated. Improvements in contact tracing are urgently needed.”

At a telebriefing held to discuss the results of his trip to Guinea, Liberia, and Sierra Leone, Dr. Frieden described progress in some areas but continued growth in Ebola cases in other areas. Lingering unmet needs throughout the region continue to challenge response efforts.

“In Liberia, the outbreak has slowed dramatically and at the moment the country has the upper hand against the virus, in part due to improvements in access to Ebola Treatment Units and Community Care Centers, safe burials, and community engagement,” Dr. Frieden said. “But the outbreak continues to surge in Sierra Leone, and there has been a troubling spread in Guinea’s capitol city. We’ve got a long way to go and this is no time to relax our grip on the response.”

During his week in West Africa, Dr. Frieden witnessed the hard work and expertise of the more than150 CDC experts who are in the field each day, including running laboratories for Ebola testing, tracking cases and contacts, advising hospitals on infection control practices, training front-line health workers, and developing health messages to encourage changes in the type of behaviors contributing to virus spread.

“CDC staff are committed to this cause because they understand the urgency in stamping out Ebola in West Africa. I am inspired by their dedication,” Dr. Frieden said. “Stopping this outbreak at its source in West Africa is essential in order to protect Americans. That is why CDC is on the ground,” Dr. Frieden said.

The recent approval of $1.2 billion to strengthen international response and preparedness, as well as $571 million for domestic preparedness, is crucial to stop Ebola and improve the United States’ ability to quickly respond to health threats like Ebola in the future.

Ebola survivors

The case fatality rate in West Africa’s ongoing Ebola epidemic – estimates range from 60 percent to 70 percent of those hospitalized – hides a hopeful statistic: the fact that many Ebola patients survive. There now are thousands of Ebola survivors.

In this epidemic as in past Ebola outbreaks, survivors often face stigma, income loss, and both grief and survivor guilt over the loss of family and friends. Many if not all of their possessions have been destroyed to prevent disease transmission. In some cases, families have been reluctant to accept orphaned children.

Two reports in the December 12 early release issue of CDC’s Morbidity and Mortality Weekly Report (MMWR) detail programs in Liberia and Sierra Leone to help Ebola survivors reintegrate with their communities and resume their lives. As survivors are thought to have some protective immunity to the strain of Ebola that sickened them, many survivors now work as caregivers for other Ebola patients.

“Nothing says more about the resilience of the human spirit than Ebola survivors who become role models for their communities,” said CDC Director Tom Frieden, M.D., M.P.H. “They show others that Ebola can be defeated and provide care, support, and inspiration for others stricken by this terrible disease.”

According to an August 2014 survey by the Sierra Leone Ministry of Health and Sanitation, CDC, and other partners, 96 percent of the general population reported at least some discriminatory attitude toward people with Ebola. This stigma discourages people from seeking Ebola testing and treatment and increases the already difficult task of contact tracing. It extends to Ebola survivors, who may be shunned by their communities.

CDC staff joined a consortium of members of the Sierra Leonean government, nongovernment organizations, and donor agencies to assess the needs of Ebola survivors. The group performed a study of three districts heavily affected by Ebola, convened a National Survivor Conference, conducted focus groups with survivors, and observed counseling sessions at a survivor wellness center.

The study found that survivors faced immediate and long-term concerns about physical and mental health, stigma, psychosocial issues including shame and survival guilt, reintegration needs, and financial needs. Despite these needs, survivors reported inadequate counseling, community reintegration, and material support.

Survivors showed great interest in contributing to the Ebola response through activities such as sharing their stories directly through radio and other broadcast media. They also expressed interest in participating in direct Ebola care and treatment support in and providing spiritual support to other Ebola patients to give them hope. Survivors said that supporting themselves with this work would help restore their own dignity.

The consortium now is coordinating financial and psychosocial support for survivors. This support includes a “survivor packet” that includes cash, bedding, clothing, and other essentials of daily living. Counselors will accompany survivors when returning to their home villages to facilitate reintegration, and trained counselors are speaking with local traditional authorities and other community members about the importance of survivor acceptance. Survivor support centers are being established at the district level, and plans are underway to integrate survivors into Ebola response activities.

In August 2014, the Firestone District of Liberia, where Firestone Liberia Inc. provides health care to 80,000 residents, enrolled their first patient in a model Ebola survivor reintegration program. The program was designed to offer survivors psychosocial support as well as to lessen stigma, provide hope, and motivate community members to report suspect Ebola cases and to seek care early in the course of disease.

“Well-coordinated survivor reintegration programs help stop the spread of Ebola and heal communities,” Dr. Frieden said. “Businesses can follow Firestone’s excellent example and contribute to the effort to get to zero in this Ebola epidemic.”

From August through October, 2014, 22 patients with laboratory-confirmed Ebola recovered from their illness at the Firestone Ebola Treatment Unit (ETU). During the three days between their first negative Ebola test and a second test confirming that they were Ebola free, survivors were transferred to a recovery room in the ETU and given education and counseling.